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Chapter 212. Occupational Noneczematous Skin Diseases Due to Biologic, Physical, and Chemical Agents: Introduction

Paul X. Benedetto; James S. Taylor; Apra Sood

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    AMA Citation
    Benedetto PX, Taylor JS, Sood A. Benedetto P.X., Taylor J.S., Sood A Benedetto, Paul X., et al.Chapter 212. Occupational Noneczematous Skin Diseases Due to Biologic, Physical, and Chemical Agents: Introduction. In: Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leffell DJ, Wolff K. Goldsmith L.A., Katz S.I., Gilchrest B.A., Paller A.S., Leffell D.J., Wolff K Eds. Lowell A. Goldsmith, et al.eds. Fitzpatrick's Dermatology in General Medicine, 8e New York, NY: McGraw-Hill; 2012. http://accessmedicine.mhmedical.com/content.aspx?bookid=392&sectionid=41138945. Accessed January 18, 2019.
    MLA Citation
    Benedetto PX, Taylor JS, Sood A. Benedetto P.X., Taylor J.S., Sood A Benedetto, Paul X., et al.. "Chapter 212. Occupational Noneczematous Skin Diseases Due to Biologic, Physical, and Chemical Agents: Introduction." Fitzpatrick's Dermatology in General Medicine, 8e Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leffell DJ, Wolff K. Goldsmith L.A., Katz S.I., Gilchrest B.A., Paller A.S., Leffell D.J., Wolff K Eds. Lowell A. Goldsmith, et al. New York, NY: McGraw-Hill, 2012, http://accessmedicine.mhmedical.com/content.aspx?bookid=392&sectionid=41138945.

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Occupational Skin Diseases Due to Biologic, Physical, and Chemical Agents at a Glance
  • Certain occupations are associated with an increased risk of infection (viral, bacterial, fungal, parasitic), arthropod bites and stings, or infestations.
  • Mechanical trauma is common in the workplace and can have skin manifestations.
  • Preexisting skin conditions may be aggravated by work-related mechanical trauma.
  • Occupational skin granulomas can be immunogenic (e.g., beryllium induced) or nonimmunogenic (e.g., silica induced).
  • Occupational skin diseases can result from excessive heat, cold, and other atmospheric factors such as low humidity in the workplace.
  • Exposure to silica, vinyl chloride, and other chemical agents can cause systemic sclerosis and limited scleroderma-like disease.
  • Occupational chloracne is one of the most sensitive indicators of toxic exposure to halogenated aromatic hydrocarbons such as dioxins and PCBs.
  • Occupational skin cancers due to exposure to chemical carcinogens or to ultraviolet light are a major health concern.

Noneczematous skin diseases caused by biologic, physical, and chemical agents in the workplace are discussed in this chapter. Trauma-related eczema is also included. For epidemiology, incidence, and management of occupational skin diseases, refer to Chapter 211.

Workers in healthcare, food services, cleaning and maintenance, and outdoor occupations are at a risk of developing skin infections. Table 212-1 lists some of the occupations associated with increased risk of certain infections.1

Table 212-1 Occupational Skin Infections
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Table 212-1 Occupational Skin Infections
Occupational Groups at Risk137Infections
Agricultural workers, farmers, shepherds, cattle workers, ranchers, animal scientists, animal breeders, veterinariansOrf, milker's nodules, tinea barbae dermatophyte infections, mycetoma, chromoblastomycosis, sporotrichosis, cutaneous larva migrans
Athletes (wrestlers, surfers, swimmers, football, hockey and beach volleyball players, triatheletes)Herpes gladiatorum, tinea corporis gladiatorum, impetigo, furunculosis, seabather's eruption, swimming pool granuloma (M. marinum), pseudomonas (“hot tub”) folliculitis, acne mechanica, cutanea larva migrans
Butchers, meat handlers, abattoir workers138Staphylococcal and streptococcal infections, cutaneous anthrax, viral warts, erysipeloid, tularemia, brucellosis, leptospirosis
Construction and other outdoor workersBlastomycosis, coccidioidomycosis, arthropod bites
Cooks, bakers, food handlers, dishwashers, cannery workers, bartenders, others doing wet workCandidal intertrigo, paronychia, pseudomonas folliculitis
Fish merchants and fishermenStaphylococcal, streptococcal infections, erysipeloid, vibrio vulnificus, aeromonas hydrophilia
Foresters, huntersTularemia, Lyme disease
GardenersSporotrichosis
Hairdressers, manicuristsStaphylococcal and streptococcal infections
Healthcare workers (physicians, nurses, dentists, physician and dental assistants, respiratory therapists, paramedics)Herpes simplex (herpetic whitlow), HIV infection, hepatitis, staphylococcal and streptococcal infections, candidiasis
Laboratory workersBrucellosis, tularemia, HIV infection, hepatitis, monkeypox
Military personnelStaphylococcal and streptococcal infections, dermatophyte infections, arthropod bites, leishmaniasis
Pet shop workers, aquarium handlers, fish tank cleanersFish tank granuloma (Mycobacterium marinum), monkeypox
VeterinariansCutaneous tuberculosis, cutaneous anthrax, brucellosis, tularemia, orf

See references 1–27.

HIV = human immunodeficiency virus.

Establishing a definite relationship between work and a specific infection is not always simple. Laboratory isolation of the infective organism and a supporting medical history and physical examination are helpful.

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